Timothy Trengrove-Jones
Like fashions, responses to HIV/Aids in this country seem to come in waves. And, in recent history, these waves tend to peak in March/April.
On March 21 last year, supporters of the Aids Treatment Action Campaign lay down in the streets outside Chris Hani Baragwanath hospital to campaign for affordable and accessible treatment for pregnant women and all HIV-positive people in this country.
Now, in the first March of the 2000s, the battle has intensified once more. Never before has HIV/Aids received so much coverage in our media. Never before have the issues been so clear-cut and so murky.
The catalyst for what has currently brought discussion around the pandemic to an all-time low was a speech made by Judge Edwin Cameron on March 9. Addressing the Second National Conference of People Living with Aids, the judge offered a concise summary of many crucial weaknesses in the government’s HIV/Aids policies. The Minister of Health, Manto Tshabalala- Msimang, was present and became engaged in angry exchanges with some delegates. In a letter to the Sunday Times of March 19, Judge Cameron expressed concern that a report the paper carried the previous week “trivialis[ed] the underlying issues”. In a letter of her own, the minister was self- defensive and objected to implications that she is “ignorant” and “uninformed”. She has also reiterated that the government is “intensifying our fight against HIV/Aids”.
In the current round of recrimination, it would help if we kept firmly before us the logic and spirit of Judge Cameron’s criticisms. What has been widely publicised is his claim that “it simply does not seem that the government can begin to get it right on Aids”. This is especially true of his insistence that, in addition to ethical and economic arguments, huge symbolic value would attach to a decision to institute treatments preventing mother-to-child transmission.
“By preventing through treatment,” Judge Cameron said, “we give all people affected by the epidemic hope. And when hope returns … the ignorance, fear and hatred will begin to subside. So, by showing hope through treatment, we will also address the stigma that surrounds this disease.” This message is crucial at a time when much official discourse surrounding the pandemic grows ever more confused and potentially confusing.
Judge Cameron’s analysis of a dynamic of hope is timely in another way. It comes at a time when statistics suggest that South Africa has the highest rate of HIV infections in the world. It is now estimated that each month about 5E000 babies are born with HIV. Yet the government seems intent on further research despite the proven existence of therapies that can reduce this by 50%.
Repeatedly – and understandably – questions of cost are raised. Yet Judge Cameron cites studies that indicate that “from a purely economic point of view, it is better to save young babies from HIV … and that intervention will save the country money”.
In the face of principled and informed challenges, President Thabo Mbeki has hurled allegations of intolerance at “Aids activists”. His representative, Parks Mankahlana, has suggested that proponents of mother-to-child transmission are in the pocket of large pharmaceutical companies. Each claim must be refuted.
The president is setting up a specious ideal of even-handedness and rigorous, open-minded, intellectual inquiry. In fact, his suggestion that the link between HIV/Aids needs to be reconsidered is on a par with re-examining whether smoking causes cancer. It makes a laughing stock of us.
Mankahlana’s claim is nothing short of rampant conspiracy theory. He is more than implying that the 16E 000 or so experts who annually attend HIV/Aids conferences around the world lack all moral and intellectual integrity. He also forgets that many of the most vociferous campaigners for the supply of AZT to pregnant women have also been in the forefront of attempts to get Glaxo to supply the product at cost or below.
So unhelpfully desperate has the government become that it has chosen once more to play the racism card. In Durban on March 9, Tshabalala-Msimang claimed that criticism is no more than the media “bad- mouthing the black government”. As with Mankahlana, this is a transparent case of scapegoatism. That major critics of the government’s HIV/Aids policies – Zackie Achmat, Professor Malegapuru Makgoba and Professor Mamphela Ramphele – are hostile to “the black government” would be difficult to prove. And Judge Cameron’s speech was filled with praise for many achievements of what he referred to as “our government”.
This week Mankahlana stressed that the government was backing education and condom useage. This week eminent virologist and co-ordinator of the South African Aids Vaccine Initiative, Dr Walter Prozesky, told me that “changes in behaviour … have never yet been able to control any other virus disease”.
It is painfully clear that the government’s thinking on HIV/Aids is in disarray. The minister of health urges we all wear the red HIV ribbon. Mankahlana asks, “Why is it that the only president in the world whose official portrait has the HIV-awareness ribbon emblazoned on his breast has become the subject of scorn and ridicule?” For Mankahlana the answer is that the president refuses to be the puppet of international pharmaceutical companies and accept the going consensus uncritically.
But if HIV does not lead to Aids, why wear the ribbon? If HIV does not lead to Aids, why has the president himself backed South Africa’s search for an HIV vaccine? Why, while accepting the need to inoculate children against childhood diseases, does the government spurn anti-retroviral therapies for children? After all, such prophylactic treatment is easily seen as the equivalent of inoculation, aimed at minimising the chances of illness or death from Aids.
Furthermore, the government has committed itself to providing free medical care for pregnant women. Now it transpires that such care is only available to HIV-negative mothers. Surely this introduces very questionable discrimination?
Mankahlana claims that the president “needs support not abuse”. It is worrying that criticism is so readily cast as abuse. It contradicts the very open- mindedness that the president so problematically calls for. Mankahlana claims that “we humans know very little about HIV/Aids”. This might be true of those in the presidential office, but is certainly not true of leading virologists and epidemiologists. We need to see more of the proper humility Mankahlana seems to advocate.
While the government deems it appropriate to wonder about the cause of Aids we might speculate about other causes. What prompts these extraordinary damaging delays and remarks around a crisis the president himself singles out as our greatest challenge? How do we account for these signs of denial? Could it be that the government has concluded that, given its history of bungling, if Aids does not exist, it will itself not have been in error? Sadly, this seems just weird enough to be true.
Timothy Trengrove-Jones is an academic and a writer